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BACKGROUND Cocaine abuse is a globally recognized problem with great socioeconomic and health impacts on society. We report a case of dissection of vertebral arteries and right renal artery after cocaine abuse that clinically presented as atypical headache and hypertension. CASE REPORT A 36-year-old male sought emergency care due to cervical pain after cocaine abuse. The pain was located to the right cervical side with irradiation to the homolateral temporal region. He had no previous comorbidities, except for cocaine abuse on a weekly basis. Angiotomography showed alterations compatible with recent arterial dissection of the right vertebral artery, confirmed on angioresonance. The patient received double anti-aggregation and antihypertensive drugs and was discharged. He was readmitted 5 days later due to hypertensive crisis and mild abdominal pain. Abdominal ultrasound with a Doppler of renal arteries showed signs right renal artery stenosis. Magnetic resonance angiography confirmed dissection of the same vessel. The patient underwent arteriography with stent implantation in the right renal artery. During outpatient follow-up, he progressed with gradual reduction of antihypertensive drugs. CONCLUSIONS There is only 1 case report correlating renal artery dissection with cocaine use and none with concomitant presentation of dissection in the vertebral and renal arterial beds. The scarcity of reports is a consequence of many problems. Therefore, young patients presenting with new-onset hypertension or abdominal pain and cocaine abuse history should raise suspicion for renal artery dissection.
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Dissecção Aórtica/induzido quimicamente , Cocaína/efeitos adversos , Hipertensão Renovascular/induzido quimicamente , Dissecação da Artéria Vertebral/induzido quimicamente , Adulto , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/terapia , Angiografia por Tomografia Computadorizada , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/terapia , Angiografia por Ressonância Magnética , Masculino , Artéria Renal/diagnóstico por imagem , Stents Metálicos Autoexpansíveis , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/terapiaRESUMO
BACKGROUND: Bone metabolism involves many complex pathways that are disturbed by several bone diseases. The literature shows some limitations concerning pediatric reference intervals to bone markers, mainly because of the low number of patients included in the studies, the heterogeneity of methods, beyond the fact that it is time-consuming and expensive. The aim of this study was to determine reference values for ß-isomerized carboxy-terminal telopeptides collagen type I (ß-CTX), a marker of bone resorption, for children and adolescents. METHODS: Blood samples from 246 patients were collected and ß-CTX was measured using an electrochemiluminescence immunoassay (ECLI). RESULTS AND CONCLUSIONS: We propose reference ranges for ß-CTX concentration from the 2.5 percentile and 97.5 percentile for each age group. The reference values obtained, concerning children and adolescents, might be useful in the evaluation of diseases such as osteosarcoma and anorexia in both childhood as adolescence.
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Biomarcadores/sangue , Reabsorção Óssea/diagnóstico , Colágeno Tipo I/sangue , Técnicas de Diagnóstico Endócrino/normas , Peptídeos/sangue , Adolescente , Fatores Etários , Reabsorção Óssea/sangue , Criança , Colágeno Tipo I/química , Técnicas Eletroquímicas/normas , Feminino , Humanos , Isomerismo , Medições Luminescentes/normas , Masculino , Peptídeos/química , Valores de ReferênciaRESUMO
TLR expression in neutrophils and monocytes is associated with increased cytokine synthesis, resulting in increased inflammation. However, the inflammatory pathway related to TLR and cathelicidin expression in these cells from CKD patients is unclear. To evaluate TLR4, cathelicidin, TNF-α, IL-6, IL-10 and MCP-1 expression in neutrophils and monocytes from HD and CKD patients. Blood samples were drawn from 47 CKD and 43 HD patients and 71 age and gender-matched healthy volunteers (CONT). TLR4 was analyzed using flow cytometry. Cathelicidin, TNF-α, IL-6, IL-10 and MCP-1 were analyzed via ELISA.TLR4 expression in neutrophils was higher in HD patients than in stage 3 and 4 CKD patients. In these cells, we observed a positive correlation between TLR4 and cathelicidin, TNF-α, IL-6, IL-10 and MCP-1 levels. In monocytes, TLR4 expression was significantly higher in CKD 3 and 4 groups than in the control and HD groups and positively and negatively correlated with IL-6 and MCP-1 and cathelicidin, respectively. TNF-α, IL-6 and MCP-1 serum levels were higher in HD and CKD patients than in control. Cathelicidin and IL-10 levels were only higher in HD patients. IL-6 serum levels were positively correlated with all cytokines, and cathelicidin was negatively correlated with MCP-1 (r = - 0.35; p < 0.01) and positively correlated with IL-10 (r = 0.37; p = 0.001). These results suggest that a uremic environment induces high TLR4, cathelicidin and cytokine expression and may increase inflammation. Thus, future studies should be conducted to evaluate whether TLR4 and cathelicidin should be targets for anti-inflammatory therapeutic strategies.
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Peptídeos Catiônicos Antimicrobianos/metabolismo , Citocinas/metabolismo , Inflamação/metabolismo , Monócitos/metabolismo , Neutrófilos/metabolismo , Insuficiência Renal Crônica/metabolismo , Receptor 4 Toll-Like/metabolismo , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Inflamação/etiologia , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Monócitos/patologia , Neutrófilos/patologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/patologia , CatelicidinasRESUMO
ABSTRACT Introduction: Vitamin D is considered a pre-hormone and plays a crucial role in calcium homeostasis and, consequently, in bone health. The best source of vitamin D is the skin in response to sunlight. Only small amounts of this vitamin are found in some foods (especially fatty fish), which makes availability of vitamin D in the diet limited. Brazilian population studies show that the prevalence of hypovitaminosis D in our country is high. Objective: To define the reference intervals for vitamin D [25(OH)D]. Discussion: Consensus of specialists - literature review. Conclusion: The standardization of reference intervals is fundamental for the correct diagnosis and treatment of hypovitaminosis D.
RESUMO Introdução: A vitamina D é considerada um pré-hormônio e apresenta papel crucial na homeostase do cálcio e, consequentemente, na saúde óssea. A maior fonte de vitamina D é a pele, em resposta à luz solar. Apenas pequenas quantidades dessa vitamina são encontradas em alguns alimentos (especialmente peixes gordurosos), o que faz com que a disponibilidade da vitamina D na dieta seja limitada. Estudos populacionais brasileiros demonstram que a prevalência da hipovitaminose D no nosso país é elevada. Objetivo: Definição dos intervalos de referência para vitamina D [25(OH)D]. Discussão: Consenso de especialistas - revisão da literatura. Conclusão: A padronização dos intervalos de referência é fundamental para o correto diagnóstico e tratamento da hipovitaminose D.
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BACKGROUND & AIMS: Resting energy expenditure (REE) changes in patients with chronic kidney disease (CKD) may contribute to mortality increase. The obesity and inflammation is associated with high REE and when not compensated by adequate intake, may determine an unfavorable clinical outcome in this population. We aimed to evaluate the influence of metabolic syndrome (MetS) on REE in CKD patients. METHODS: One hundred eighty-three patients were stratified according to glomerular filtration rate (GFR) and divided in groups: without CKD (GFR > 60 ml/min/1.73 m2) and CKD (GFR < 60 ml/min/1.73 m2) and according to the presence or absence of MetS. REE was measured by indirect calorimetry; body composition was assessed by bioelectrical impedance analysis and blood and urine were collected for biochemical tests. RESULTS: REE was lower in the group with CKD compared with those without CKD (1293 ± 364 vs 1430 ± 370 kcal/d, P = 0.01). The group with CKD without MetS showed decrease in REE compared to the groups without CKD, regardless the presence of Mets, and those with CKD and MetS (1173 ± 315 vs 1392 ± 324 vs 1460 ± 410 vs 1424 ± 376 kcal/d, P < 0.05, respectively). Multivariate analysis showed an independent association of CKD in determining REE when adjusted for lean body mass. The inclusion of MetS as an independent variable in the same analysis model neutralized the impact of CKD on the REE (P = 0.19). Patients without MetS, REE correlated with estimated GFR and the protein equivalent (r = 0.33, P < 0.01, r = 0.21, P = 0.04, respectively), whereas in MetS patients, these correlations were not observed. CONCLUSION: The presence of CKD is independently associated with reduced REE. The observed decrease in REE is reversed in patients with MetS independent of renal function.
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Metabolismo Energético , Síndrome Metabólica/complicações , Insuficiência Renal Crônica/complicações , Descanso , Idoso , Idoso de 80 Anos ou mais , Análise Química do Sangue , Composição Corporal , Estatura , Índice de Massa Corporal , Peso Corporal , Brasil , Calorimetria Indireta , Impedância Elétrica , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Falência Renal Crônica/urina , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/urina , Pessoa de Meia-Idade , Análise Multivariada , Avaliação Nutricional , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/urinaRESUMO
BACKGROUND: Patients undergoing orthotropic liver transplant (LTx) often present with chronic kidney disease (CKD). Identification of patients who will progress to end-stage renal disease (ESRD) might allow not only the implementation of kidney protective measures but also simultaneous kidney transplant. STUDY DESIGN: Retrospective cohort study in adults who underwent LTx at a single center. ESRD, death, and composite of ESRD or death were studied outcomes. RESULTS: 331 patients, who underwent LTx, were followed up for 2.6 ± 1.4 years; 31 (10%) developed ESRD, 6 (2%) underwent kidney transplant after LTx and 25 (8%) remained on chronic hemodialysis. Patients with preoperative eGFR lesser than 60 ml/min per 1.73 m2 had a 4-fold increased risk of developing ESRD after adjustment for sex, diabetes mellitus, APACHE II score, use of nephrotoxic drugs, and severe liver graft failure (HR = 3.95, 95% CI 1.73, 9.01; p = 0.001). Other independent risk factors for ESRD were preoperative diabetes mellitus and post-operative severe liver graft dysfunction. CONCLUSION: These findings emphasize low eGFR prior to LTx as a predictor for ESRD or death. The consideration for kidney after liver transplant as a treatment modality should be taken into account for those who develop chronic kidney failure after LTx.
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Taxa de Filtração Glomerular , Falência Renal Crônica/etiologia , Rim/fisiopatologia , Transplante de Fígado/efeitos adversos , Brasil , Distribuição de Qui-Quadrado , Progressão da Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Polymorphonuclear leukocytes (PMNs) from chronic kidney disease (CKD) patients display accelerated apoptosis and dysfunction, which may predispose CKD patients to infections. In this study, we investigated the effect of spermidine and p-cresol on apoptosis and function on PMN from healthy subjects. We measured the effect of spermidine and p-cresol on apoptosis, ROS production unstimulated and stimulated (S. aureus and PMA) and expression of CD95, caspase 3, and CD11b on PMN. After incubation with p-cresol and spermidine, we did not observe any changes in apoptosis, viability or expression of caspase 3 and CD95 in PMN from healthy subjects. PMN incubated for 10 minutes with spermidine demonstrated a significant reduction in spontaneous, S. aureus and PMA-stimulated ROS production. p-cresol induced a decrease in PMA-stimulated ROS production. Spermidine and p-cresol also induced a decrease in the expression of CD11b on PMN. Spermidine and p-cresol decreased the expression of CD11b and oxidative burst of PMN from healthy subjects and had no effect on PMN apoptosis and viability.
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Apoptose/efeitos dos fármacos , Antígeno CD11b/imunologia , Cresóis/farmacologia , Neutrófilos/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismo , Espermidina/farmacologia , Humanos , Neutrófilos/citologia , Neutrófilos/imunologia , Neutrófilos/metabolismoRESUMO
The authors evaluated the significance of metabolic syndrome (MetS) diagnosis, as defined by the National Cholesterol Education Program (NCEP) and by the International Diabetes Federation (IDF), in the evaluation of cardiovascular risk in hypertensive patients. Among 638 patients, the prevalence of MetS was 54.7% when the IDF criteria were used, compared with 45.5% when the NCEP criteria were used. MetS correlated significantly with the presence of cardiovascular disease (CVD). In patients without type 2 diabetes mellitus (T2DM), only MetS diagnosed using the IDF criteria was associated with the presence of CVD. In those with T2DM, MetS was not associated with CVD, regardless of the criteria used. The diagnosis of MetS, using either set of criteria, was associated with the development of T2DM. We conclude that, in hypertensive patients without diabetes, a diagnosis of MetS according to IDF criteria, but not the NCEP criteria, is useful in identifying individuals with a higher probability of incident CVD. In patients with diabetes, a population already considered at high risk for CVD, a diagnosis of MetS, regardless of the criteria used, has no further impact on prognosis.
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Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Hipertensão/complicações , Síndrome Metabólica/complicações , Síndrome Metabólica/diagnóstico , Glicemia/metabolismo , Pressão Sanguínea/fisiologia , HDL-Colesterol/sangue , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Masculino , Síndrome Metabólica/classificação , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Circunferência da Cintura/fisiologiaRESUMO
BACKGROUND: Ezetimibe specifically blocks the absorption of dietary and biliary cholesterol and plant sterols. Synergism of ezetimibe-statin therapy on LDL-cholesterol has been demonstrated, but data concerning the pleiotropic effects of this combination are controversial. OBJECTIVE: This open-label trial evaluated whether the combination of simvastatin and ezetimibe also results in a synergistic effect that reduces the pro-inflammatory status of pre-diabetic subjects. METHODS: Fifty pre-diabetic subjects were randomly assigned to one of 2 groups, one receiving ezetimibe (10 mg/day), the other, simvastatin (20 mg/d) for 12 weeks, followed by an additional 12-week period of combined therapy. Blood samples were collected at baseline, 12 and 24 weeks. RESULTS: Total cholesterol, LDL-cholesterol and apolipoprotein B levels decreased in all the periods analyzed (p < 0.01), but triglycerides declined significantly only after combined therapy. Both drugs induced reductions in C-reactive protein, reaching statistical significance after combining ezetimibe with the simvastatin therapy (baseline 0.59 +/- 0.14, simvastatin monotherapy 0.48 +/- 0.12 mg/dL and 0.35 +/- 0.12 mg/dL, p < 0.023). Such a reduction was independent of LDL-cholesterol change. However, mean levels of TNF-alpha and interleukin-6 and leukocyte count did not vary during the whole study. CONCLUSION: Expected synergistic lowering effects of a simvastatin and ezetimibe combination on LDL-cholesterol, apolipoprotein B and triglycerides levels were confirmed in subjects with early disturbances of glucose metabolism. We suggest an additive effect of this combination also on inflammatory status based on the reduction of C-reactive protein. Attenuation of pro-inflammatory conditions may be relevant in reducing cardiometabolic risk. TITLE/ID OF TRIAL REGISTRATION: Effect of simvastatin and ezetimibe on lipid and inflammation/NCT01103648.
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BACKGROUND/AIMS: To evaluate cystatin C as a marker of diabetic kidney disease in normoalbuminuric diabetic patients without chronic kidney disease (CKD). METHODS: A cross- sectional study was carried out comprising 243 hypertensive patients, 61 of them with type 2 diabetes, presenting normoalbuminuria and an estimated glomerular filtration rate (eGFR) >or=60 ml/min/1.73 m(2). Renal function assessment included determinations of serum creatinine and cystatin C levels, microalbuminuria, as well as eGFR through Cockcroft-Gault and Modification of Diet in Renal Disease equations. RESULTS: Diabetic patients presented higher cystatin C levels than nondiabetic patients (0.95 +/- 0.19 vs. 0.89 +/- 0.17 mg/l; p < 0.05). In the binary logistic regression, the presence of diabetes and metabolic syndrome was significantly associated with elevated cystatin C levels. Diabetic patients also presented a slightly greater albuminuria (6.72 +/- 4.43 vs. 5.07 +/- 3.59 microg/min; p < 0.05). CONCLUSIONS: Our results suggest that elevated cystatin C levels in diabetic patients may identify a certain degree of renal dysfunction even when albuminuria and eGFR do not mirror CKD. Longitudinal studies with direct GFR measures need to be done in order to confirm the value of cystatin C as an indicative of worse renal outcomes in the diabetic population.
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Cistatina C/sangue , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Diagnóstico por Computador/métodos , Taxa de Filtração Glomerular , Biomarcadores/sangue , Brasil/epidemiologia , Nefropatias Diabéticas/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
It has been suggested that phosphate binders may reduce the inflammatory state of hemodialysis (HD) patients. However, it is not clear whether it has any effect on oxidative stress. The objective of this study was to evaluate the effect of sevelamer hydrochloride (SH) and calcium acetate (CA) on oxidative stress and inflammation markers in HD patients. Hemodialysis patients were randomly assigned to therapy with SH (n=17) or CA (n=14) for 1 year. Before the initiation of therapy (baseline) and at 12 months, we measured in vitro reactive oxygen species (ROS) production by stimulated and unstimulated polymorphonuclear neutrophils and serum levels of tumor necrosis factor alpha, interleukin-10, C-reactive protein, and albumin. There was a significant reduction of spontaneous ROS production in both groups after 12 months of therapy. There was a significant decrease of Staphylococcus aureus stimulated ROS production in the SH group. There was a significant increase in albumin serum levels only in the SH group. In the SH group, there was also a decrease in the serum levels of tumor necrosis factor alpha and C-reactive protein. Our results suggest that compared with CA treatment, SH may lead to a reduction in oxidative stress and inflammation. Therefore, it is possible that phosphate binders exert pleiotropic effects on oxidative stress and inflammation, which could contribute toward decreasing endothelial injury in patients in HD.
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Mediadores da Inflamação/sangue , Inflamação/sangue , Estresse Oxidativo/efeitos dos fármacos , Proteínas de Ligação a Fosfato/uso terapêutico , Diálise Renal/efeitos adversos , Acetatos/uso terapêutico , Adulto , Biomarcadores/sangue , Compostos de Cálcio/uso terapêutico , Feminino , Humanos , Inflamação/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Poliaminas/uso terapêutico , Espécies Reativas de Oxigênio/metabolismo , Sevelamer , Resultado do TratamentoRESUMO
Hyperuricemia is a common finding in hypertensive patients, especially among those who are on diuretic therapy. However, its clinical relevance regarding cardiovascular and chronic kidney disease (CKD) has not clearly been established. The authors assessed whether, in a population of 385 hypertensive women categorized according to diuretic therapy, the stratification in quartiles by uric acid levels would identify a gradient of changes in renal function and in risk factors for cardiovascular disease. The following were evaluated: serum uric acid, glycemia, total and fractional cholesterol, triglycerides, apolipoprotein (Apo) B, Apo A-I, and C-reactive protein. Renal function was assessed by serum creatinine, albuminuria, and estimated glomerular filtration rate (eGFR) by the Modification of Diet in Renal Disease equation, whereas cardiovascular risk was estimated through the Framingham score. A total of 246 women were on diuretic therapy; 139 were taking other antihypertensive medications. There was a reduction in eGFR parallel to the increase in uric acid levels, regardless of diuretic use and without a concomitant increase in albuminuria. In both groups, higher uric acid levels translated into an increase in metabolic syndrome components, in markers of insulin resistance, triglyceride / high-density lipoprotein levels, and Apo B/Apo A-I ratios, as well as in Framingham scores. Hyperuricemia was associated with an increase in inflammatory markers only in patients on diuretic therapy. In a binary logistic regression, hyperuricemia (uric acid >6.0 mg/ dL) was independently associated with CKD (eGFR <60 mL/ min / 1.73 m(2)) (odds ratio, 2.63; 95% confidence interval, 1.61-4.3; P<.001). In hypertensive women, the presence of hyperuricemia indicated a substantial degree of kidney dysfunction as well as a greater cardiovascular risk profile.
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Diuréticos/uso terapêutico , Hipertensão/tratamento farmacológico , Hiperuricemia/sangue , Nefropatias/sangue , Rim/fisiopatologia , Ácido Úrico/sangue , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/epidemiologia , Doença Crônica , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Hiperuricemia/etiologia , Hiperuricemia/fisiopatologia , Nefropatias/etiologia , Nefropatias/fisiopatologia , Lipídeos/sangue , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
OBJECTIVES: Clinical laboratories store filter paper samples used in neonatal screening for various periods of time after performing hormonal measurements. However, due to lack of data concerning specimen stability, it is unclear for how long these samples should be stored. The objective of this study is to determine the stability and reproducibility of thyroid-stimulating hormone (TSH), thyroxine (T(4)) and 17-hydroxyprogesterone (17-OHP) measurements in filter paper blood samples stored for up to 60 months. METHODS: Two hundred and twenty-eight blood samples, drawn between the second and the fourth day of life, were divided into seven distinct groups and kept at 4-8 degrees C for one day or 2, 12, 24, 36, 48 or 60 months after basal hormonal measurements. In each group, TSH, T(4) and 17-OHP levels were initially assayed 24-48 hours after collection (basal) and repeated once at the end of storage timing. All the measurements were performed by time-resolved fluorometry (1235 AutoDELFIA, Wallac Oy, Turku, Finland). Repeated and basal levels of each hormone were compared within the same group by Student's paired t-test. Differences were considered significant at P < 0.05. RESULTS: Compared with basal measurements, TSH and T(4) levels declined significantly only when these hormones were re-assayed at 48 or 60 months of sample storage. In contrast, 17-OHP concentrations decreased earlier, starting at 24 months and continuing throughout the remaining period. CONCLUSION: Our data suggest that neonatal screening of filter paper samples kept at 4-8 degrees C are reliable for repeating the hormonal measurements when specimens are stored for up to one year, in the case of 17-OHP, or three years, in the case of T(4) and TSH.
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17-alfa-Hidroxiprogesterona/sangue , Coleta de Amostras Sanguíneas/instrumentação , Tireotropina/sangue , Tiroxina/sangue , Estabilidade de Medicamentos , Humanos , Recém-Nascido , Papel , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
OBJECTIVE: Continuous renal replacement therapy is commonly used in the treatment of acute kidney injury. Although the optimal anticoagulation system is not well defined, citrate has emerged as the most promising method. We evaluated the data of 143 patients with acute kidney injury subjected to citrate-based continuous venovenous hemodiafiltration. DESIGN: Retrospective cohort study. SETTING: Intensive care unit of tertiary care private hospital. PATIENTS: Patients with acute kidney injury treated from February 2004 to July 2006. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main cause of acute kidney injury was sepsis (58%). The mean dialysis dose was 36.6 mL/kg/hr allowing for excellent metabolic control (last tests: creatinine, 1.1 mg/dL; urea, 46 mg/dL). No significant bleeding, severe electrolyte, or calcium disorders were observed. Of the 418 filters used, almost 28,000 hrs of treatment, hemofilter patency was 68% at 72 hrs. Hospital mortality was 59%, and 22% of survivors were dialysis-dependent at the time of discharge. Within our sample, we identified 21 patients with liver failure (mean prothrombin time index, 21% vs. 67%, p < 0.001). This group presented with a lesser median systemic ionized calcium level (1.06 vs. 1.12 mmol/L, p < 0.001) and similar mean total calcium level (8.5 vs. 8.6 mg/dL, not significant), compared with patients without liver failure. These subjects also showed acidemia (median pH, 7.31 vs. 7.40, p < 0.001); however, they exhibited higher levels of lactate (median 29 vs. 16 mg/dL, p < 0.001), chloride (mean 109 vs. 107 mEq/L, p = 0.045) and had a trend to higher mortality rate (76% vs. 56%). CONCLUSIONS: Besides a trend toward higher mortality rate observed in the group with liver failure, we found that citrate-based continuous venovenous hemodiafiltration allowed an effective dialysis dose and reasonable filter patency.
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Injúria Renal Aguda/terapia , Anticoagulantes/administração & dosagem , Citratos/administração & dosagem , Hemodiafiltração/métodos , Injúria Renal Aguda/sangue , Adolescente , Adulto , Idoso , Anticoagulantes/efeitos adversos , Citratos/efeitos adversos , Estudos de Coortes , Cuidados Críticos , Feminino , Humanos , Falência Hepática/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/complicações , Resultado do TratamentoRESUMO
BACKGROUND: Nitric oxide (NO) released from endothelial cells is related to the maintenance of physiological vascular tone. The impairment of endothelial NO generation brought about by gene polymorphism is considered one of the deterioration factors in progressive renal disease. In the endothelial nitric oxide synthase (eNOS) intron 4 polymorphism, the presence of the aa genotype has been associated with cardiovascular and renal disease. The aim of this study was to investigate the presence of eNOS gene intron 4 polymorphism in patients with end-stage renal disease (ESRD). METHODS: A total of 114 patients and 94 controls were studied. DNA specimens were extracted from blood and amplified by polymerase chain reaction. The alleles were separated by agarose gel electrophoresis. Genotype distribution and allele frequencies were compared between groups using the chi-squared test. RESULTS: Statistical analysis revealed that the frequency of the eNOS4 genotype aa was significantly different in ESRD patients and in controls (P=0.016, OR=2.07, CI 95%: 1.14-3.74). There was also a statistically significant difference between ESRD patients and controls regarding allele carriers (P=0.004; OR=2.26; CI 95%: 1.29-3.96). When the frequencies of allele carriers in the diabetic nephropathy group and in the control group were compared, a significant difference was found (P=0.034, OR=2.28; CI 95%: 1.04-5.00). CONCLUSION: This study showed a strong correlation between eNOS4a polymorphism and end-stage renal disease.
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Falência Renal Crônica/genética , Óxido Nítrico Sintase Tipo III/genética , Polimorfismo Genético , Feminino , Frequência do Gene , Genótipo , Humanos , Íntrons/genética , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da PolimeraseRESUMO
OBJECTIVE: To establish the cut-off values of GH measured by immunofluorometric assay, a more sensitive and specific assay, in normal prepubertal children and compare their values with those of proven GH-deficient patients. METHODS: 30 normal children (20 males) and 26 patients with known causes of GH deficiency were submitted to the clonidine test and their GH values were compared. A powdered clonidine tablet (0.1 mg/m(2)) was given orally and blood samples for GH measurements were drawn at times -30, 0, 60, 90 and 120 min. RESULTS: GH peak values presented a wide variation ranging from 1.7 to 25 micro g/l (mean +/- SD = 12.87 +/- 5.8 micro g/l) in the normal group. The cut-off values for the 5th and 10th percentiles of the distribution curve were 3.3 and 5.5 micro g/l, respectively. In the GH deficiency group, maximum GH levels after clonidine stimulation ranged from <0.1 to 2.1 micro g/l (0.56 +/- 0.58 micro g/l). CONCLUSIONS: The cut-off values obtained with the immunofluorometric method are lower than the ones obtained by radioimmunoassay. We suggest a cut-off value of 3.3 micro g/l (5th percentile) that ensures 100% of sensitivity along with 93% of specificity to exclude the diagnosis of GH deficiency when using this immunofluorometric method.
Assuntos
Agonistas alfa-Adrenérgicos/farmacologia , Clonidina/farmacologia , Hormônio do Crescimento Humano/efeitos dos fármacos , Hormônio do Crescimento Humano/deficiência , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Técnica Direta de Fluorescência para Anticorpo , Hormônio do Crescimento Humano/sangue , Humanos , Lactente , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Masculino , Valores de ReferênciaRESUMO
Comparar o emprego de uma formulaçäo galêmica única da associaçäo do antagonista de cálcio dihidropiridínico nlodipino com o inibidor da enzima de conversäo enalapril, em duas dosagens diferentes, com a utilizaçäo isilada de cada um dos componentes da associaçäo notratamento de pacientes hipertensos essenciais leves a moderados. Utilizou-se um estudo multicêntrico, duplo cego, randomizado e paralelo. Foi avaliada a eficácia anti-hipertensiva com medida da pressäo arterial no consultório e monitorizaçäo ambulatorial da pressäo arterial (MAPA), a tolerabilidade, a segurança clínica por exames clínico-aboratoriais, os efeitos nos metabolismos glicídico e lipídico e na morfometria e funçäo cardíada. Visando avaliar de forma objetiva e temporal o desenvolvimento eventual do adverso do edema de membros inferiores, foi determinado de modo seriado o volume das pernas dos pacientes pela técnicaque utiliza o princípio de Arquimedes. O estudo teve duraçäo de 24 semanas e foram incluídos 99 pacientes com pressäo darterial diastólica entre 90 e 115 mm Hg após três semanas de retirada da medicaçäo anti-hipertensiva. Os esquemas terapêuticos mostraram-se seguros e adquados ao tratamento. A associaçäo galênica de anlodipino e enalapril nas duas doses empregadas apresentou, pela medida da pressäo arterial no consultório e por MAPA, eficácia anti-hipertensiva semelhante ao emprego de anlodipino isolado e superior à observada com uso exlusivo do enalapril. Ressalta-se que a eficácia da associaçäo foi obtida com doses menores que as empregadas com cada droga isolada. As duas dosagens da associaçäo mostraram perfil de tolerabilidade superior ao do anlodipino ou do enalapril isolados, com reduçäo significativa da incidência de tosse e de edema de membros inferiores, que foi acompanhada de um menor aumento no volume da perna. O tratamento com a associaçäo näo modificou os parâmetros metabólicos e determinou reduçäo nos 1ndices da morfometria do ventrículo esquerdo. A formulaçäo galêmica de anlodipino e enalapril é segura, útil, de alta eficácia e de melhor tolerabilidade que o emprego de cada componente isolado no tratamento de pacientes com hipertensäo essencial leve `a moderada
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Anti-Hipertensivos/uso terapêutico , Di-Hidropiridinas/uso terapêutico , Enalapril/uso terapêutico , Frequência Cardíaca , Hipertensão/tratamento farmacológico , Pressão Arterial , Combinação de MedicamentosRESUMO
Serum prolactin level is very important to discriminate prolactiomas from other causes of hyperprolactinemia, specially pseudoprolactinomas. We describe two hyperprolactinemic men: case 1 is 28y old with headache, left eye visual loss and ptosis associated with a huge mass of the sellar region who was operated on elsewhere by transcranial route. These was no visual amelioration. Two months after surgery the patient was admitted to our Unit with impairment of right eye vision. Galactorrhea was found and imaging evaluation showed persistence of a large tumor. After blood sampling for hormonal assessment, oral bromocriptine (10 mg/day) was started and a dramatic right visual improvement was noticed. However, basal prolactin by immunoradiometric assay (IRMA) was 97mug/L. Due to the clinical signs and response suggesting prolactinoma, prolactin level was reassessed. A two-incubation and serial dilution of the same sample up to 1:1,200 disclosed a prolactin value of 25,572 mug/L. Case 2 is 20y old with headache, bitemporal hemianopsia, seizures and hypogonadism secondary to a giant tumor arising from the sellas region. Initial serum prolactin level measured by IRMA was 104 mug/L, which after two-incubations and dilutions up to 1:200 disclosed a value of 17,736 mug/L; clinical treatment was instituted with good results. In order to avoid unnecessary surgeries, we recommend a two-incubation procedure in routine prolactin determinations when IRMA is used.